Forensic medical evaluation of children who present with suspected sexual abuse: How do we know what we know?

The past 40 years have seen significant changes in the way children's genital findings are interpreted in the context of suspected sexual abuse. Many findings previously thought to be diagnostic of sexual abuse are now recognised to be normal variants, caused by other medical conditions or have insufficient specificity to make a definite diagnosis of abuse. Use of the Adams classification in recent years has provided a common language and practical framework for describing and categorising genital findings in children. This review article addresses our current understanding of how to interpret genital findings in children, the evidence on which this interpretation is based, gaps that remain in our knowledge and suggestions for future research.